Types of Periodontal Disease

Periodontal disease can refer to any condition that affects the structures supporting your teeth. However, the most common forms of periodontal disease are caused by bacterial infections of the gums, connective tissue or bone around the teeth.Therefore, the term periodontal disease generally refers to diseases associated with dental plaque, which contains bacteria. These can range from mild gingivitis, in which only the gums are affected, to severe disease that causes loss of the supporting structures of the tooth, and results in tooth loss.

There are several types of periodontal disease.

Gingivitis

Gingivitis is the mildest form of periodontal disease and involves the gums. It's caused by bacteria in plaque, which produce substances that can harm the gums.

Gingivitis is quite common. Almost 75% of adults over age 35 have some evidence of this condition. Certain groups of people are at increased risk.

If you have gingivitis,

Your gums will be red and swollen, and bleed easily.

There is usually little or no discomfort, but gingivitis can progress to a more serious form of periodontal disease, called periodontitis.

Gingivitis can be reversed with professional treatment (a thorough cleaning, including removal of plaque below the gum line) and good oral care at home.

Chronic Periodontitis

Periodontitis is a more advanced form of periodontal disease than gingivitis. Periodontitis involves all of the supporting tissues of the teeth: the gums, connective tissue and bone.

Chronic periodontitis is the most common form of periodontitis. Between 10% and 15% of the population has some degree of periodontitis. The older you are, the more likely you are to get the disease.

If you have periodontitis, your gums become detached from your teeth, causing spaces to form between the teeth and gums. These spaces are called periodontal pockets. The dental plaque that accumulates in these pockets eventually causes the destruction of bone that supports the teeth. In the more severe stages of periodontitis, teeth can become loose and may even fall out.

Periodontitis usually is not painful. Some people notice that their gums are bleeding and receding, and that they have bad breath or a bad taste in their mouth. However, periodontitis sometimes does not cause any symptoms that you would notice,although your dentist can diagnose it during an examination. The condition usually worsens quite slowly, over several years.

Unlike gingivitis, periodontitis cannot be completely reversed because the lost supporting tissues usually are impossible to rebuild. However, treatment and good oral hygiene can improve your oral health, stop the progression of periodontitis, and prevent tooth loss and other serious consequences.

Aggressive Periodontitis

Aggressive periodontitis progresses faster than chronic periodontitis. Aggressive periodontitis tends to run in families, and is more common in smokers.

Aggressive periodontitis used to be considered a "young person's disease," but it is no longer classified this way. However, it is more common in younger people than chronic periodontitis. Like chronic periodontitis, aggressive periodontitis is caused by the bacteria found in dental plaque. Recent research has suggested that susceptibility to this form of periodontitis is an inherited trait.

The treatment for this disease generally is the same as treatment for chronic periodontitis. However, aggressive periodontitis can be more difficult to treat than the chronic form of the disease, and some people do not respond to treatment.

Periodontitis as a Symptom of Systemic Diseases

Periodontitis can be a symptom of one of several systemic diseases including certain types of leukemia’s, neutropenias and genetic disorders. The characteristics of this type of periodontitis usually depend on the underlying medical condition, although the disease can look and act like aggressive periodontitis. These gum conditions are most common in younger patients who do not have large accumulations of dental plaque.

The treatment for this type of periodontitis involves controlling the underlying medical problem first, followed by treatment similar to that for chronic or aggressive periodontitis.

Other medical conditions,such as diabetes and HIV infection, can intensify all forms of periodontitis. People with these diseases are more prone to developing severe periodontitis. However, unlike people who have periodontitis as a manifestation of systemic disease, these individuals usually have a fair amount of dental plaque and/or calculus (tartar) on their teeth.

Necrotizing Periodontal Diseases

Necrotizing periodontal diseases are rapidly progressing forms of disease that are characterized by loss of the little triangles of tissue between the teeth, bleeding gums and significant pain. Other symptoms include bad breath and a whitish film on the surface of the gums. Patients with these forms of periodontal disease also may develop a fever and swollen glands.

The American Academy of Periodontology recognizes two forms of necrotizing periodontal diseases:

ulcerative gingivitis(NUG) (

and necrotizing ulcerative periodontitis (NUP).

As the names imply, NUG results in destruction of gum tissue while NUP affects the gums, connective tissue and alveolar bone.

These conditions most commonly are observed in people whose immune systems have been suppressed. Risk factors include smoking, poor nutrition, psychological stress, and HIV infection.

The treatment for NUG typically involves oral hygiene instruction, scaling and root planing, systemic antibiotics, and the use of a mouth rinse containing chlorhexidrine. Because NUP, a relatively rare form of periodontal disease, maybe associated with underlying medical conditions such as HIV infection, your dentist will consult with your physician. The treatment is very similar to that for NUG, and may include use of antifungal medications.